Agency for healthcare research and quality , website Guide to Health Care

How has the womens movement been instrumental in changing health care practices?

ex; provision of childbirth services in more relaxed settins, the need for research that examines women equally to men

What are two serious problems of health services in the U.S.?

uneven distribution and increased specialization

Case Method

a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets

Functional Method

focuses on the jobs to be completed, task-oriented approach, personnel with less preparation than the professional nurse perform less complex care requirements. based on production and efficiency model that give authority to the head nurse

Primary Nursing

a system in which one nurse is responsible for overseeing the total care of a number of hospitalized clients 24 hours a day, 7 days a week, a method or providing comprehensive, individualized and consistent care

Medicare Part A

available to people with disabilities and people over 65 years of age, provides insurance towards hospitilization, home care and hospice

Medicare Part B

voluntary and provides partial coverage of outpatient and physician services to people who are eligible for part A

Medicare Part D

voluntary prescription drug plan

Medicaid

1965, title 19, federal public assistance program paid out of taxes, people with low incomes, paid by federal and state governments

SSI

persons with disabilities or those who are blind, available people not eligible for SS, not restricted to health care costs

somewhat like HMOs and PPOs, clients pay a fixed payment to the IPA, at end of year any surplus money is divided among the providers

Physician/Hospital Organizations

joint ventures between a group of private physicians and a hospital, may be part of an intergrated delivery system, which incorporates all health care throughout the life span

what is an example of a primary prevention activity?

Nutrition counseling for young adults with a strong family history of high cholesterol

Who are public health agencies funded by and what do they do?

funded by governernments to investigate and provide health programs

In most cases, clients must have a primary care provider in order to receive health insurance benefits. If a client is in need of a primary care provider, it is most appropriate for the nurse to recommend what type of provider?

Family practice physician

The most significant method for reducing the ongoing increase in the cost of health care in the United States includes controlling what?

Numbers of uninsured and under insured persons

A client is seeking to control health care costs for both preventive and illness care. Although no system guarantees exact out of pocket expenditures, the most prepaid and predictable client contribution would be seen with?

A health mainteance organization (HMO)

Case-management

Range of models for integrating health care services for individuals or groups

Coinsurance

The percentage share of a government-approved charge that is paid by the client

Critical Path Ways

An interdisciplinary plan or tool that specifies interdisciplinary assessments, interventions, treatments, out-come for health-related conditions across a time line

Diagnosis-related groups (DRG)

A classification system that establishes pretreatment diagnosis billing categories

Preferred Provider (PPAs)

Health care plan that contracts with individual health care providers

Differentiated practice

System in which the best use of nursing personnel is based on their educational preparation and skill sets

Health maintenance organization (HMO)

A group health care agency that provides health maintenance and treatment to voluntary enrollees

Independent practice associations (IPAs)

Similiar to HMOs, care is provided in offices, where the client pays a fixed amount to the IPA

Provides direct client care under the direction of a registered nurse, physician or other licensed practitioner

Managed Care

A health care system whose goals are to rpovide cost-effective, quality care

Medicaid

Federal public assistance program that provides health care coverage to people who require financial assistance

Medicare

National and state health insurance program for older adults

What are the three types of health care services?

Primary prevention, Secondary prevention, Tertiary prevention

What is the purpose of primary prevention health care systems?

Health promotion and illness prevention

What is the purpose of secondary prevention?

Rehabilitation, health restoration, and palliative care

What is the purpose of tertiary prevention?

Rehabilitation, health restoration and palliative care

What are the primary goals of Health People 2012

a. increase quality and years of a health lifeb. achieve health equity and eleminate health disparitiesc. create healthy environments for everyoned. promote health and quality life across the life span

What is an example of secondary prevention?

Physicians offices

____ is the official agency at the federal level for public health.

Public Health Service (PHS) of the U.S. Department of Health and Human Services

According to the U.S. Census, the expected number of frail elderly (people over 85) will be the ______ growing population segment in the U.S. and will number over _____million by 2020 and _____million by 2030.

fastest, 76.5, 90

What impact does the Health Insurance Portability and Accountability Act of 1996 (HIPPA) have on the health care system?

major alteration in how health care is practiced, regulations protect privacy of individuals, violations can result in heavy fines

What is the definition of critical pathways, and how are critical pathways used in case management and managed care?

case management used as a cost-containment strategy in managed care, both systems often use critical pathways in an interdisciplinary plan or tool that specified interdisciplinary assessments, interventions, treatments and outcomes for health-related conditions across a time line

You are taking the health and physical assessment for an 80 year old blind client who has just been admitted to the unit. What type of health coverage could she have at this point?

could have private pay, Medicare, Medicaid or Supplemental Security Income

If the client's income is below the poverty level, what type of coverage could also be included in the health coverage plan?

Supplemental Security Income is available for persons with diabilities or those who are blind or not eligible for Socail Security

After caring for a client for 3 days, she is getting ready for discharge. The physician has written an order for physical therapy after discharge. In addition, he request that a dietitian follow up with additional education regarding the client's newly diagnosed type II diabetes. What roles do the two providers fufill?

The physical therapy could be performed by the physical therapist. Physical therapist treat movement dysfunction by means of heat, water, exercise, massage and electric current. They also assess client mobility and strength, provide therapeutic measures, and teach new skills. A dietitian has special knowledge about the diets required to maintain health and treat disease.

Where could the client receive the services, and what type of coverage could possibly pay for these services?

long-term health care facility that has rehabiliation services or home health care, medicare part B and the SSI could supplement it as needed

Refer to the Research Note in the textbook to answer the following questions regarding the types of nurses and delivery models in hospitals and how these factors influence patient outcomes? How was the quality of care measured?

measured through the patient outcomes; rates of medication errors, falls and certain infections

What types of models were used? Define each of these models?

total care (case method)-client centered, one nurse is assigned to and is responsible for the comprehensive care of a group of clients during an 8 to 12 hour shift. team nursing-delivery of individualized nursing care led by a professional nurse, consists of registered nurses, licensed practical nurses, & unlicensed assistive personnelprimary nursing-one nurse is responsible for overseeing the total care of a number of clients 24 hours a day, 7b days a week, even if he or she does not personally deliver all the care

How were quality, coordination, and communication in the units affected?

The results were higher on units that had all registered nurses as opposed to staffing the included unlicensed personnel and practical nurses. The total care delivery model had the lowest quality.

Why is this research important in today's health care delivery systems?

shows a relationship between the composition of the nursing staff and the quality of patient care, important to examine delivery models to allow optimal deployment of registered nurses in a time of nursing shortage

Name two frameworks for care that are used for the delivery of nursing care that supports continuity of care and cost-effectiveness:

managed care and team nursing

Medicare is divided into two divisions, Part A and Part B. Another plan was added in January 2006. Part A is the